Streams

If This Pill Prevents HIV, Why Is No One Taking It?

Friday, January 31, 2014

Truvada (Jeffrey Beall/Wikipedia Commons)

It’s been over a year since The FDA approved Truvada, a once a day medication that prevents HIV infection. But why are so few people taking it? Dr. Robert Grant, a professor at the University of California San Francisco, talks about the drug and why it’s slow to catch on. He’s the lead scientist who developed the treatment, which is known as “pre-exposure prophylaxis” or PrEP.

Guests:

Dr. Robert Grant

The Morning Brief

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Comments [21]

What about just avoiding anal penetration? Said act is, after all, the single, overwhelming factor that accounts for HIV rates among homosexually-active males that are as high as forty-four times those of the general population (CDC). In contrast to a pharmaceutical, simply not buggering carries no risks, has no side effects and doesn't cost a penny. And such a prudent /behavioral choice/ is not only at /least/ as effective as any pill (and far more effective than condoms) in preventing HIV but also prevents a whole host of other serious and even deadly infections that are also disproportionately spread via this inherently unhygienic, anatomy- and physiology-defying act (buggery; anal penetration). (But such a simple behavioral choice doesn't generate revenue for anyone, does it?)

All this is amply pointed-out by voices as emphatically PRO-homoerotic as Man2Man Alliance and Frot Men Founder Bill Weintraub:
http://man2manalliance.org (WARNING: Graphic, brutally honest content)
(DISCLAIMER: Quoting/citing does not necessarily equal endorsement)

A longtime gay activist, Weintraub coined the term "Frot" for the non-penetrative, phallus-on-phallus act that he advocates as the natural, safe, dignified and fully-egalitarian truest form of male homosexual intercourse.

Rob McGee is another unapologetic homosexual who touts Frot for the same advantages. On his blog at http://funfrotfacts.blogspot.com , McGee points-out the following:

_______Begin Quoted Text_______
In 1985, which is to say just a few years before C. Everett Koop's AIDS letter, the Dutch government launched a two-pronged AIDS prevention campaign aimed at gay/bi men. The message was very simple:

(1) If you are a man who has sex with other men, the surest way to avoid AIDS is to abstain completely from anal intercourse.

(2) If you are unwilling to abstain from anal sex, you must use a condom every time.
[....]
"By the early '90s, the language of the Dutch campaign had been changed -- totally dropping the "don't have anal sex at all" suggestion. (Which was, let's remember, MERELY a suggestion, as the libertarian Netherlands had abolished its anti-sodomy laws as of 1813 .) In place of the two-pronged approach, the revised language put all the AIDS-prevention eggs into just one basket. That basket being, of course, "Use a condom every time you have anal sex." Which in no time at all got truncated to "Use a condom every time" -- thus subtly reinforcing the highly dubious notions that breaking-and-entry through the backdoor is not only "vanilla," but also the Default Mode of male/male sex."
_______End Quoted Text________
Full-text at:
http://funfrotfacts.blogspot.com/2009/07/letter-i-sent-to-my-mean-and-judgmental.html

Mar. 09 2014 09:35 AM
Demarcus Jackson from Tennessee

Basic advertising. I haven't seen one TV spot on the pill and I've seen very little in the way of magazine advertising or promotion of the pills in health units or hospitals. Today, I've watched commercials for pills and medicines that get you hard, help with bladder problems, help you shit regularly, slow down the flu, control cholesterol, help you quit smoking, manage depression, and even a commercial for Pseudobulbar affect (PBA).

Not one...NOT ONE...commercial for this remarkable HIV preventing treatment.

Feb. 07 2014 02:10 PM

In preemption, to those who would:
a) liken advocating that homosexual males (as well as everyone else) abstain from the specific act of anal penetration to advocating that heterosexual couples abstain from vaginal penetration,
and,
b) argue that the latter would be preposterous and that the former, therefore, is as well,
I answer as follows.

First of all, /if/ vaginal intercourse were anywhere near as unhygienic, unsafe and anatomically and physiologically-unsound (and, many would insist, inherently gruesome, if not brutal, if not downright /sadistic/) as anal penetration so empirically and manifestly is, then, yes, I absolutely would advocate abstention from vaginal penetration as well. But this is simply not the reality. Far from it.

Second, as it is, I already advocate abstention from vaginal intercourse (as well as all forms of sexual contact, really but intercourse especially) for everyone other than couples who are not only married to each other but are also prepared and committed to actually take responsibly for any pregnancy that might result through their actions. (This does not mean ripping their emerging offspring from the womb but giving it a proper life.)

The analogy is fatally flawed, as only it could be. This would be obvious from even the most cursory comparison between the anatomy and physiology of the vagina and that of the anus, respectively. As the aforementioned Bill Weintraub so succinctly put-it: "no magic or wishful thinking can transform either the anus or the rectum into genital organs" - ibid.

Feb. 02 2014 06:20 PM
LESBlue from Alphabet City NYC

It is cause for circumspection. From reading the comments there is plenty of misunderstanding about how the drug works. For example as to Brad's comment : Most people I know use it as PEP (or maybe for a weekend here and there.

From listening to the interview what I gather is that one needs to get the drug into one's system and keep it there. Thus just taking it on Thursday in preparation for a party weekend and having unprotected sex is a really bad idea.
Speaking to people I know in the field of HIV prevention they point out that it is a good tool for certain people esp people in sex work and people in relationships with HIV pos partners. Further they say there are plenty of people that can not function sexually with a condom on. It's a real problem for them.

Dr. Grant makes a plea for people to stop being judgmental and see this as a possible tool in the prevention of HIV. He also acknowledges that it may lead to the spread of other STD's resulting from the lack of condom use.

Personally I'm not sold but I am listening. I am concerned that spotty drug regime compliance with lead to mishaps. I think I will be the boring old guy (48) who watched his friends die through the 80's and 90's who sticks with the rubbers.

Jan. 31 2014 09:37 PM
LESBlue from Alphabet City NYC

It is cause for circumspection. From reading the comments there is plenty of misunderstanding about how the drug works. For example as to Brad's comment : Most people I know use it as PEP (or maybe for a weekend here and there.

From listening to the interview what I gather is that one needs to get the drug into one's system and keep it there. Thus just taking it on Thursday in preparation for a party weekend and having unprotected sex is a really bad idea.
Speaking to people I know in the field of HIV prevention they point out that it is a good tool for certain people esp people in sex work and people in relationships with HIV pos partners. Further they say there are plenty of people that can not function sexually with a condom on. It's a real problem for them.

Dr. Grant makes a plea for people to stop being judgmental and see this as a possible tool in the prevention of HIV. He also acknowledges that it may lead to the spread of other STD's resulting from the lack of condom use.

Personally I'm not sold but I am listening. I am concerned that spotty drug regime compliance with lead to mishaps. I think I will be the boring old guy (48) who watched his friends die through the 80's and 90's who sticks with the rubbers.

Jan. 31 2014 09:36 PM
Ed from Larchmont

One does have to ask: should we pay for this for other people?

Jan. 31 2014 12:40 PM
Mark from Bronx

Does this guest receive financial consideration from the manufacturer of the drug which he is talking about.

Jan. 31 2014 12:38 PM
BK from Hoboken

@ Ed-
Yes there are same sex couples throughout the world who enjoy sex as well. Welcome to reality. Where is this contradiction?

Jan. 31 2014 12:36 PM
Joe from Brooklyn

My partner and I are contemplating opening up our relationship under strict rules - would it be a good idea for us to start regimens on this if it's affordable?

Jan. 31 2014 12:29 PM
Mark G from Manhattan

Wait how can you be undetectable and have HIV? Suppose some one that is "undetectable" donates blood .. or organs

THIS is a problem.. Let's not get emotional about the response .. but if it can't be detectable but is STILL there then the blood supply is not safe..

Jan. 31 2014 12:29 PM
Brad from NYC

I just tuned in, but I have always thought the idea of taking a DAIILY combo of 2-3 antiviral meds for prevention is a bit crazy. Most people I know use it as PEP (or maybe for a weekend here and there. I realize this raises resistance concerns, but then so does daily use, widespread.

They also use a Triple V combo to protect them against other STDs.

Jan. 31 2014 12:27 PM
Amy from Manhattan

Most of this discussion has been about sexual transmission of HIV. Does it make any difference in the effectiveness of Truvada if the risk comes from injection drug use? (I can't think of any reason it would, but I haven't heard it mentioned yet.)

Jan. 31 2014 12:26 PM
Ed from Larchmont

This is a good thing, but at the same time we're promoting same sex interaction, a contradiction here?

Jan. 31 2014 12:23 PM
Sheldon from Brooklyn

If men can't be trusted to change their underwear regularly, I'm not sure that they will have the discipline to take this pill religiously on schedule, and that can lead to a false sense of security.

The use of this pill may be perfect for the adult film industry and sex workers though.

Jan. 31 2014 12:22 PM
ben hodges

I have researched this thoroughly as my husband is HIV + and while this is a promising therapy and I understand your guest's desire to facilitate use of this drug, there is a chance (however small) that it is not going to prevent infection. He is making it sound like it is 100% effective. Please give us percentages. This is no magic pil..

Jan. 31 2014 12:19 PM
Alan from Williamsburg

You mentioned in the introduction that even though Truvada was approved by the FDA "and paid for by most insurance companies"....but does insurance really pay for at-risk prophylavxis with Truvada, which is a very expensive medication, or only for those already infected?

Jan. 31 2014 12:19 PM
Jenna from LES

Doesn't this pill cost $1000 a month?

Jan. 31 2014 12:18 PM
Rachel from Sunset Park

Hi,
Can you talk about the HIV research that Jeff McConnell did at UCSF? He passed on Saturday and it would be great if you could recognize him.

Thank you.

Jan. 31 2014 12:18 PM
Sara from UES

Is this supposed to be used in lieu of condoms?

Jan. 31 2014 12:17 PM
Michelle C from LIC

Is there a risk of a population developing resistance to this drug that hinders effective treatment for infected people down the line? Also, how is this functionally different from a vaccine?

Jan. 31 2014 12:15 PM
Brett from UES

I'm a gay man and my boyfriend is HIV+. We use protection and are very careful. He is undetectable and we always use protection. I've considered this pill but I wonder what the long term health risks of it are.

Jan. 31 2014 12:03 PM

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